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Eitzman EA, Kroll RG, Yelavarthy P, Sutton NR. Predicting Contrast-induced Renal Complications. Interv Cardiol Clin 2023; 12:499-513. [PMID: 37673494 DOI: 10.1016/j.iccl.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Chronic kidney disease is an independent risk factor for the development of coronary artery disease and overlaps with other risk factors such as hypertension and diabetes. Percutaneous coronary intervention is a cornerstone of therapy for coronary artery disease and requires contrast media, which can lead to renal injury. Identifying patients at risk for contrast-associated acute kidney injury (CA-AKI) is critical for preventing kidney damage, which is associated with both short- and long-term mortality. Determination of the potential risk for CA-AKI and a new need for dialysis using validated risk prediction tools identifies patients at high risk for this complication. Identification of patients at risk for renal injury after contrast exposure is the first critical step in prevention. Contrast media volume, age and sex of the patient, a history of chronic kidney disease and/or diabetes, clinical presentation, and hemodynamic and volume status are factors known to predict incident contrast-induced nephropathy. Recognition of at-risk patient subpopulations allows for targeted, efficient, and cost-effective strategies to reduce the risk of renal complications resulting from contrast media exposure.
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Affiliation(s)
- Emily A Eitzman
- Cardiovascular Research Center, 7301A MSRB III, 1150 West Medical Center Drive, Ann Arbor, MI 48109-0644, USA
| | - Rachel G Kroll
- Cardiovascular Research Center, 7301A MSRB III, 1150 West Medical Center Drive, Ann Arbor, MI 48109-0644, USA
| | | | - Nadia R Sutton
- Department of Internal Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA.
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Altıparmak IH, Tanrıverdi Z, Taşcanov MB, Güngören F, Biçer A, Fedai H, Toprak K, Elmas AN, Demirbağ R. C-Reactive Protein/Albumin Ratio as a Novel Predictor of Contrast Induced Nephropathy in Patients With Stable Angina Pectoris. Angiology 2023; 74:189-196. [PMID: 35589620 DOI: 10.1177/00033197221103635] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The relationship between C-reactive protein (CRP) to albumin ratio (CAR) and contrast-induced nephropathy (CIN) in patients with acute coronary syndrome has been reported. However, the relevance of CAR in patients with stable angina pectoris (SAP) has not been clarified. We hypothesized that CAR might predict the development of CIN in patients with SAP undergoing coronary angiography (CAG). Patients (n = 554) with SAP who underwent CAG were included in the study. CIN was defined as a ≥25% increase in serum creatinine compared with baseline value within 72 h of CAG. Participants were divided into two groups: CIN (n = 87) and non-CIN (n = 467). Age, CRP, CAR, mean corpuscular volume (MCV), urea, uric acid, contrast medium volume, the percent of percutaneous coronary intervention were significantly greater, whereas albumin and high-density lipoprotein were significantly lower in the CIN group than non-CIN group (p < .05, for all). Multivariate analysis showed that CAR was the only independent predictor for CIN (odds ratio = 7.065, 95% confidence interval (CI); 3.279-15.221, p < .001). Receiver operating characteristic ROC analysis showed that a CAR ≥ 0.1164 could predict CIN (sensitivity of 71% and specificity of 72%; area under curve = 0.736; 95% CI: 0.677-0.795, p < .001). CAR was significantly greater in patients who developed CIN and this independently predicted CIN.
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Affiliation(s)
| | - Zülkif Tanrıverdi
- Department of Cardiology, 111374Harran University, Faculty of Medicine, Şanlıurfa, Turkey
| | - Mustafa Begenç Taşcanov
- Department of Cardiology, 218511Şanlıurfa Education and Research Hospital, Şanlıurfa, Turkey
| | - Fatih Güngören
- Department of Cardiology, 111374Harran University, Faculty of Medicine, Şanlıurfa, Turkey
| | - Asuman Biçer
- Department of Cardiology, 111374Harran University, Faculty of Medicine, Şanlıurfa, Turkey
| | - Halil Fedai
- Department of Cardiology, 218511Şanlıurfa Education and Research Hospital, Şanlıurfa, Turkey
| | - Kenan Toprak
- Cardiology Clinic, Siverek State Hospital, Şanlıurfa, Turkey
| | - Ali Nizami Elmas
- Department of Cardiology, 111374Harran University, Faculty of Medicine, Şanlıurfa, Turkey
| | - Recep Demirbağ
- Department of Cardiology, 111374Harran University, Faculty of Medicine, Şanlıurfa, Turkey
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Tsai CT, Lu YW, Chou RH, Kuo CS, Huang PH, Wu CH, Huang SS. Effect of timing of coronary revascularization in patients with post-infectious myocardial infarction. PLoS One 2022; 17:e0272258. [PMID: 35980880 PMCID: PMC9387830 DOI: 10.1371/journal.pone.0272258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/15/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives
Acute infection is a well-known provocative factor of acute myocardial infarction (AMI). Prognosis is worse when it is associated with sepsis. Coronary revascularization is reported to provide benefit in these patients; however, the optimal timing remains uncertain.
Methods
This retrospective study was performed at a tertiary center in Taipei from January 2010 to December 2017. 1931 patients received coronary revascularization indicated for AMI. Among these, 239 patients were hospitalized for acute infection but later developed AMI. Patients with either an ST-elevation myocardial infarct or the absence of obstructive coronary artery disease were excluded. Revascularization was performed via either percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). We defined early and delayed revascularization groups if it was performed within or after 24 hours of the diagnosis of AMI, respectively. We evaluated whether the timing of revascularization altered 30-day and one-year all-cause mortality.
Results
At one month, 24 (26%) patients died in early revascularization group and 32 (22%) patients in delayed revascularization group. At one year, 40 (43%) and 59 (40%) patients died on early and delayed revascularization groups respectively. Early revascularization did not result in lower 30-day all-cause mortality (P = 0.424), and one-year all-cause mortality (Hazard ratio (HR): 0.935; 95% confidence interval (CI): 0.626–1.397, P = 0.742) than delay revascularization.
Conclusions
Timing of coronary revascularization of post infectious acute coronary syndrome may be arranged according to individual risk category as those without sepsis.
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Affiliation(s)
- Chuan-Tsai Tsai
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Cardiovascular Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Ya-Wen Lu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Cardiovascular Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Ruey-Hsing Chou
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Cardiovascular Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Chin-Sung Kuo
- Cardiovascular Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Po-Hsun Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Cardiovascular Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - Cheng-Hsueh Wu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Cardiovascular Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- * E-mail: (S-SH); (C-HW)
| | - Shao-Sung Huang
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Cardiovascular Research Center, National Yang-Ming Chiao Tung University, Taipei, Taiwan
- * E-mail: (S-SH); (C-HW)
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Sun X, Fan Z, Liu Z, Li J, Hua Q. Red blood cell distribution width-to-albumin ratio: a new inflammatory biomarker to predict contrast-induced nephropathy after emergency percutaneous coronary intervention. Int Urol Nephrol 2022; 54:3283-3290. [PMID: 35799040 DOI: 10.1007/s11255-022-03290-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/26/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE Contrast-induced nephropathy (CIN) remains a dreaded complication in the cardiac diagnostic and interventional area. We investigated the relationship between red blood cell distribution width-to-albumin ratio (RAR) and CIN in elderly patients with ST-segment elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI). METHODS A total of 1532 elderly patients were enrolled and divided into the CIN group and the non-CIN group. The risk factors of CIN were evaluated by univariate and multivariate regression analysis. Receiver-operating characteristic (ROC) curve analysis was used to identify the best predictive value. RESULTS CIN occurred in 129 (8.42%) patients. Patients in the CIN group had significantly higher RAR than those in the non-CIN group (4.69 ± 0.73 vs. 3.18 ± 0.64, P < 0.001). In multivariate regression analysis, RAR was an independent risk factor for the development of CIN (OR: 1.506, 95% CI: 1.227-2.083, P = 0.025), along with age, creatinine, eGFR, hs-CRP and contrast agent dose. The AUC of RAR was 0.755 (95% CI 0.703-0.807), and an optimal cutoff value of 3.64 or higher predicted CIN with a sensitivity of 76.2% and specificity of 65.7%. CONCLUSION As a combined inflammatory-related index, RAR was an independent risk factor for the development of CIN in elderly patients with STEMI undergoing emergency PCI. The RAR could be a simple but relatively reliable parameter for identifying high-risk patients.
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Affiliation(s)
- Xipeng Sun
- Department of Cardiology, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
| | - Zhenxing Fan
- Department of Cardiology, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
| | - Zhi Liu
- Department of Cardiology, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
| | - Jing Li
- Department of Cardiology, Xuanwu Hospital Capital Medical University, Beijing, 100053, China
| | - Qi Hua
- Department of Cardiology, Xuanwu Hospital Capital Medical University, Beijing, 100053, China.
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Katte JC, Kengne AP, Tchapmi D, Agoons BB, Nyirenda M, Mbacham W, Sobngwi E. Procalcitonin Correlates With Cardiovascular Risk Better Than Highly Sensitive C-Reactive Protein in Patients With Type 2 Diabetes in Sub-Saharan Africa: Results From a Cross-Sectional Study. Cureus 2021; 13:e18357. [PMID: 34725609 PMCID: PMC8553282 DOI: 10.7759/cureus.18357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 11/17/2022] Open
Abstract
Objective Inflammatory markers such as C-reactive protein and procalcitonin have been shown to be independent markers of cardiovascular diseases. We aimed to assess the correlation between serum levels of procalcitonin, C-reactive protein and cardiovascular risk in type 2 diabetes. Methods We carried out a cross-sectional study at a tertiary level reference hospital in Yaounde, Cameroon. We assessed the cardiovascular risk using the Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation (ADVANCE) cardiovascular risk prediction model in 80 adults with type 2 diabetes. Serum procalcitonin and C-reactive protein were measured in 80 and 76 subjects respectively, using a highly sensitive quantitative enzyme-linked immunosorbent assay (ELISA) method. Correlations were examined using Spearman's rank correlation test and the correlation coefficients were compared using the Z-test statistic. Results Females represented the majority of the study population (62.5%). The median duration of diabetes was 5 (3-10) years and 62.5% of participants had a high cardiovascular risk score. Median serum procalcitonin levels was significantly higher in females compared to male participants: 2.48 (1.76-3.01 ng/mL) vs 1.42 (0.86-1.87 ng/mL); p<0.001. There was no difference in the serum C-reactive protein levels between females and males: 1.20 (0.33-3.33) mg/L vs 0.85 (0.36-2.77) mg/L; p=0.669. Procalcitonin was moderately correlated with cardiovascular risk (r=0.58, p<0.001). The correlation was slightly higher in females (R=0.56, p<0.001) versus males (R=0.49, p=0.005) although not significantly different (Z-statistic=0.734, p=0.463). Serum C-reactive protein did not show a meaningful correlation with cardiovascular risk (R=0.23, p=0.050). At a threshold of 2 ng/ml, serum procalcitonin identified participants with a high cardiovascular risk score, with a sensitivity and specificity of 64% and 80% respectively. Conclusion Compared to C-reactive protein, procalcitonin may be a better surrogate marker for cardiovascular risk prediction in this population with type 2 diabetes.
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Affiliation(s)
- Jean-Claude Katte
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, CMR
| | - Andre-Pascal Kengne
- Department of Medicine, Non-Communicable Diseases Unit, South African Medical Research Council, Cape Town, ZAF
| | - Donald Tchapmi
- Department of Medicine, Nguelemendouka District Hospital, Ministry of Public Health, Cameroon, Yaounde, CMR
| | - Batakeh B Agoons
- Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, CMR
| | - Moffat Nyirenda
- Department of Medicine, Non-Communicable Diseases Theme, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, UGA
| | - Wilfried Mbacham
- Department of Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaoundé, CMR
| | - Eugene Sobngwi
- Department of Internal Medicine, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, CMR
- Endocrinology and Metabolism, National Obesity Centre and Endocrinology and Metabolic Diseases Unit, Yaoundé Central Hospital, Yaoundé, CMR
- Department of Medical Research, Biotechnology Centre, University of Yaoundé 1, Yaoundé, CMR
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Predictive value of oxidant and antioxidant status for contrast-induced nephropathy after percutaneous coronary intervention for ST-segment elevation myocardial infarction. Rev Port Cardiol 2021. [DOI: 10.1016/j.repc.2020.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Predictive value of oxidant and antioxidant status for contrast-induced nephropathy after percutaneous coronary intervention for ST-segment elevation myocardial infarction. Rev Port Cardiol 2021; 40:489-497. [PMID: 34274095 DOI: 10.1016/j.repce.2021.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 08/25/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) is a life-threatening complication after primary percutaneous coronary intervention (p-PCI). Oxidative stress and inflammation may play an important role in the development of CIN. OBJECTIVE We aimed to assess the relationship between total oxidant status, total antioxidant capacity, high-sensitivity C-reactive protein (hs-CRP), gamma-glutamyltransferase and uric acid (UA) in the development of CIN in patients presenting with ST-elevation myocardial infarction (STEMI). METHODS This prospective cohort study consisted of 341 patients with STEMI. Patients were divided into two groups: those with and those without CIN. Predictors of CIN were determined by multivariate regression analyses. RESULTS Multivariate regression analysis showed that initial glucose level, contrast media volume/glomerular filtration ratio (eGFR) ratio, hs-CRP, UA and oxidative status index were associated with the development of CIN in patients with STEMI. CONCLUSION The main finding of this study is that increased oxidative stress and inflammation parameters were associated with the development of CIN in patients with STEMI. Other independent predictors of CIN were contrast media volume/eGFR ratio, initial glucose level, UA and hs-CRP.
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Wang J, Zhang C, Liu Z, Bai Y. Risk factors of contrast-induced nephropathy after percutaneous coronary intervention: a retrospective analysis. J Int Med Res 2021; 49:3000605211005972. [PMID: 33878914 PMCID: PMC8072857 DOI: 10.1177/03000605211005972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Contrast-induced nephropathy (CIN) is a serious complication in patients with acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). This study aimed to analyze the potential risk factors for CIN in patients undergoing PCI. Methods Patients with ACS who underwent PCI treatment from January 2017 to January 2020 were selected. The patients’ characteristics and medical information were collected and compared. Results A total of 1331 patients undergoing PCI were included. The incidence of CIN was 15.33%. Logistic regression analyses showed that a left ventricular ejection fraction ≤45% (odds ratio [OR] 4.18, 95% confidence interval [CI] 1.10–7.36), serum creatinine levels ≤60 μmol/L (OR 3.03, 95% CI 1.21–5.57), age ≥65 years (OR 2.75, 95% CI 1.32–4.60), log N-terminal pro-B-type natriuretic peptide levels ≥2.5 pg/mL (OR 2.31, 95% CI 1.18–5.13), uric acid levels ≥350 μmol/L (OR 2.29, 95% CI 1.04–5.30), emergency percutaneous intervention (OR 1.35, 95% CI 0.34–3.12), and triglyceride levels ≤1.30 mmol/L (OR 1.10, 95% CI 0.01–2.27) were independent risk factors for CIN in patients who underwent PCI. Conclusions Early prevention is required to reduce the occurrence of CIN in patients who undergo PCI and have risk factors for CIN.
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Affiliation(s)
- Jing Wang
- Department of Cardiology, Yan'an University Affiliated Hospital, Yan'an, China
| | - Chunyu Zhang
- Nursing Teaching and Research Department, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Yan'an, China
| | - Zhina Liu
- Department of Cardiology, Yan'an University Affiliated Hospital, Yan'an, China
| | - Yanping Bai
- Department of Cardiology, Yan'an University Affiliated Hospital, Yan'an, China
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Li X, Zhang L, Yu B, Yang L, Zhang H, Huang G, Tang L, Xu M, Zhou J, Xiao L, Tang J, Liu X, Shu C. High sensitivity C reactive protein level is associated with prognosis in patients with severe coronavirus disease 19 pneumonia. VASCULAR INVESTIGATION AND THERAPY 2021. [DOI: 10.4103/2589-9686.32192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Effects of Altered Levels of Pro- and Anti-Inflammatory Mediators on Locations of In-Stent Reocclusions in Elderly Patients. Mediators Inflamm 2020; 2020:1719279. [PMID: 33029103 PMCID: PMC7530477 DOI: 10.1155/2020/1719279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/19/2020] [Accepted: 08/27/2020] [Indexed: 02/08/2023] Open
Abstract
Imbalances of proatherogenic inflammatory and antiatherogenic inflammatory mediators were involved in the pathogenesis of atherosclerosis. This study sought to investigate the effects of proatherogenic inflammatory and antiatherogenic inflammatory mediators on the proximal, middle, and distal coronary artery reocclusions in elderly patients after coronary stent implantations. We measured the expression levels of proatherogenic inflammatory/antiatherogenic inflammatory cytokines. This included interleukin-1 β (IL-1 β), interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α), high-sensitivity C-reactive protein (hs-CRP), interleukin-10 (IL-10), interleukin-17 (IL-17), interleukin-13 (IL-13), and interleukin-37 (IL-37) in the elderly patients with the proximal, middle, and distal coronary artery reocclusions after coronary stent implantations. Levels of IL-1 β, IL-6, IL-8, TNF-α, and hs-CRP were remarkably increased (P < 0.001), and levels of IL-10, IL-17, IL-13, and IL-37 were remarkably lowered (P < 0.001) in the elderly patients with the proximal, middle, and distal coronary artery reocclusions. Imbalances of proatherogenic inflammatory and antiatherogenic inflammatory mediators may be involved in the formation and progression of proximal, middle, and distal coronary artery reocclusions in elderly patients after coronary stent implantations.
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